TOPLINE

Poor manager support, excessive workplace demands, strained relationships, and constant organisational change were the most harmful stressors for ambulance staff in England, significantly affecting mental health, a study found.

METHODOLOGY

• Researchers conducted a mixed-methods explanatory sequential stress audit in one ambulance service within the NHS in England.
• Participants (n = 420; 44.8% men and 38.1% women) included frontline ambulance workers (57.4%), clinical hub and dispatch staff (13.6%), and support role workers (9.5%), with varying tenure in role and band levels.
• An online survey was used to collect and evaluate data on occupational stress, stress appraisals, mental rest, depressive symptoms, well-being, and turnover intentions in staff members.
• Semistructured interviews were conducted with seven ambulance staff including one manager, as well as with one occupational health professional.
• The researchers examined potential relationships between stress-related variables and outcomes and group differences.

TAKEAWAY

• Workplace demands (beta-coefficient, -0.43; P < .001) and poor mental rest (beta-coefficient, -0.42; P < .001) were the strongest predictors of depressive symptoms among the surveyed ambulance staff.
• Poorer well-being was most strongly predicted by poor mental rest (beta-coefficient, 0.63), stress appraisal (beta-coefficient, 0.47), manager support (beta-coefficient, 0.41), and change (beta-coefficient, 0.42; P < .001 for all).
• Intention to leave was primarily driven by high job demands (beta-coefficient, -0.49), poor manager support (beta-coefficient, -0.48), poor workplace relationships (beta-coefficient, -0.47), poor mental rest (beta-coefficient, -0.43), and change (beta-coefficient, -0.42; P < .001 for all).
• Men reported more depressive symptoms (P = .040) and a higher intention to leave (P = .001) than women; personnel with longer tenures (> 2 years) reported higher levels of both outcomes than those with shorter tenures (< 2 years).

IN PRACTICE

"[The study] findings are building blocks for the structure of a tailored stress management strategy for ambulance staff. The 'primary' intervention (aimed at preventing or reducing stressors), which is in line with our findings regarding the impact of the accumulation of stressors, should include both organisational and individual components," the authors wrote.

SOURCE

The study was led by Zoe Anchors, University of Bath, Bath, England. It was published online on July 09, 2026, in BMJ Open.

LIMITATIONS

The study was limited by execution within a single ambulance service in England, the cross-sectional survey design, and the potentially simplified presentation of the nuanced intersections between stressors and individual characteristics. The lack of a formal assessment for missing survey data and the possibility of bias further limited the study.

DISCLOSURES

The research was funded by the NHS Bristol, North Somerset and South Gloucestershire Integrated Care Board. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.